Blunt Intestinal Trauma

During the 5-year period from January 1978 through December 1982, 196 patients with blunt trauma to the small bowel, colon, or mesentery were treated at the Maryland Institute for Emergency Medical Services Systems (MIEMSS) Shock Trauma Center. More than 80% of these patients were the victims of motor vehicle accidents and therefore commonly had multisystem injuries. Sixty of these patients suffered 83 major injuries in the form of perforation or mesenteric injury resulting in ischemic bowel. This group accounted for 6.9% of the 870 patients who had celiotomy for blunt trauma during this period. Several significant observations were made. All injuries, except one, were diagnosed by peritoneal lavage. Only two duodenal injuries were present. Perforations involving the jejunum and ileum were distributed throughout the entire length of the small bowel. Colon injuries comprised one-fourth of the major injuries, with most occurring in the ascending and sigmoid colon. There were 16 deaths, 6 of which occurred as a result of complications from the bowel injury.